Some questions may not apply.Please designate N/A in that instance.Attach additional sheets as needed for any explanations.

Part II.Parking:

a.How many persons
with disabilities parking spaces are available? ____ If these are in a parking
lot, how many total parking spaces are available? ____ Are each identified with
an upright sign? ____ Where is the designated parking in relationship to the
primary entrance? _______________________________________________

b.Are access aisles
adjacent to the persons with disabilities parking spaces? ____ How wide are the
parking spaces? __________ How wide are the aisles? ____________

c.Do handicapped
parking spaces allow people to get in or out on a level surface? ____

d.Does the
individual using the persons with disabilities parking space have to navigate
behind parked cars to gain entrance to the building? ______

Part III.Sidewalks:

a.How wide are the
public sidewalks? _______ Are they level? _______ If not, do they slope away
from the building, toward the building, or along the length of the walk?
________________________________

b.Is there at least
one sidewalk with no steps leading tot he primary entrance? ____ Does the
sidewalk connect to the persons with disabilities parking area? ____ Is there a
curb cut at the end of the sidewalk? ____ If so, how high is the curb? _____
and how long is the curb cut or sloped portion of the sidewalk? _____ Is the
curb cut surface a different texture than the sidewalk? _____

c.Are walks of a
continuing common surface and not interrupted by steps or abrupt changes in

level? _____

d.Do walks have a
level platform at the door which is at least 5 feet by 5 feet? __________ If
not, what is the size of the level platform? ________________ Does the door
swing in or out? ______________

Part III.Entrances/Exits:

a.Is at least one
primary entrance to the building on ground level or with a ramped approach?
_______ How many floors/levels does this building have? ___________ If more
than one, is the entrance on the same level as access to the elevator?
__________

b.If more than one
floor, can access be gained to all meeting rooms, offices, and common areas
from the elevator? __________ At what height are the elevator controls? (top
and bottom) _____________ Are the buttons labeled with raised or indented
letters? __________ What are the inside dimensions of the elevator?
_____________________

c.If a ramp is
used, what is the height of the rise it serves? __________ What is the length
of the

ramp? ________ Is there a handrail on at least one side of
the ramp? _________ Is this ramp of permanent construction? __________

d.Is the primary
entrance unlocked at all times? __________

e.What is the width
of the entrance door? _______________ If double doors, what is the width of
each door? __________ Are there doors in a series at the entrance? ___________
If so, how far apart are the doors? _____ Which way do they swing? ______ Is
the handle of a lever or loop type? __________

f.Is the height of
the threshold ½ or less? __________

g.Does the primary
entrance contain a revolving door or turnstile? ______ If so, is there a usable
door at the same location? ______

h.What pressure
pull is required to open the primary entrance door? __________ (NOTE:an easy tool to measure this is a fishing
scale)

i.Is the symbol of
accessibility used to designate barrier free entrance? ______

Part IV.Interior Circulation:

a.Do all doors have
a clear opening of at least 32 when open? __________ Do all doors operate with
a single effort? __________ What pull/push weight is required to operate doors?
___________ Do the doors have lever or loop type handles? __________

b.Is the floor on
the inside and outside of each doorway level for a distance of 5 feet from the
door in

the direction the door swings? __________ Does the flat
surface extend 15 to 18 on each side of the door? __________

c.Does any interior
doorway have a threshold over ½? __________

d.If interior ramps
are used, what is the height of the rise? __________ What is the length of the

ramp? __________ Is a handrail installed on at least one
side of the ramp? __________ Does the ramp have a non-slip surface? ______ What
is the height of the handrail? ______ Do the handrails extend 1 foot beyond
each end of the ramp? ______

e.What is the
height of the phones? ____________ If water fountains are provided, what is the
height of the spout? _____________

g.Are there fire
extinguishers, plants, other obstacles protruding from the wall that do not
reach the

floor?If so, how
far do they protrude? __________

Part V.Restrooms:

a.Are there toilet
rooms and/or stalls designed to be accessible? __________ Are there any steps
or obstructions leading to the toilet rooms? ___________ What is the clear
opening width of the entrance door? __________ Are there doors in a series?
__________ If so, how far apart are they? __________ If a 90-degree turn is
required in the entrance, what is the corridor width? __________ What pressure
pull is required to open the door(s)? __________

b.Is there at least
one place in the toilet room that provides a full 5 foot diameter open floor
space?_____ How wide is the area between the wall and the front of the stalls?
__________ If stalls are provided, what are the dimensions of the largest
compartment? _____________________ Does the door on the compartment swing out?
_____ What is the open width of the door? __________ Are grab bars provided?
_____ If so, at what height are they mounted? __________ How many grab bars are
in

the compartment? ___________ Are they located on the side or
behind the stool?

__________ What is the diameter of the grab bar? __________
How far away from the wall is it

located? ___________

c.What is the
height of the stool? _____ What is the height of the urinal? __________ Are
there grab bars at the urinal? ________ What is the height of the towel or
towel dispense? ________ What is the height

of the soap dispenser? ________ What is the height of the
lower edge of the mirror? ________ What is

the measurement from the lower edge of the lavatory to the
floor? ________ Are dispensers located at

the side of or above the lavatory? ________

d.Do appropriate
signs identify accessible toilet facilities? __________ Are the handles of the
faucets single handle or blade type? __________ Are the drain and hot water
pipes wrapped? __________

Part VI.Other:

a.Are switches and
controls for light, heat, ventilation, window draperies, fire alarms and all
similar controls of frequent or essential use within 54 of the floor?
___________ and higher than 18 from the floor? ___________